Background: Healthcare restrictions during the COVID-19 pandemic, particularly in ophthalmology, resulted in a differential underutilization of care with potential long-term consequences. An analytic approach is needed to characterize pandemic health services usage across many conditions.
Methods: A common analytical framework identified pandemic care utilization patterns across 261 ophthalmic diagnoses. Using a United States eye care registry, predictions of utilization expected without the pandemic were established for each diagnosis via models trained on pre-pandemic data. Pandemic effects on utilization were estimated by calculating deviations between observed and expected patient volumes from January 2020 to December 2021. Two sub-periods of focus were defined: the hiatus (March-May 2020), when many clinical visits were curtailed, and post-hiatus (June 2020-December 2021). Characteristics of conditions with similar deviation patterns were ascertained from cluster analyses, data visualizations, and hypothesis testing.
Results: Analyzing records from 44.62 million patients and 2,455 practices, we observed lasting reductions in ophthalmic care utilization, including visits for leading causes of visual impairment (age-related macular degeneration, diabetic retinopathy, cataract, glaucoma). Mean deviations among all diagnoses were 67% below expectation during the nadir of the hiatus (April 2020), and 13% post-hiatus. Less severe conditions experienced greater utilization reductions, with heterogeneities across diagnosis categories and pandemic phases. Intense post-hiatus utilization reductions occurred among non-vision-threatening conditions or asymptomatic precursors of vision-threatening diseases. Many conditions with above-average post-hiatus utilization posed a risk for irreversible morbidity, such as emergent pediatric, retinal, or uveitic diseases.
Conclusions: We derived high-resolution insights on pandemic care utilization from high-dimensional data using an analytical framework that can be applied to study healthcare disruptions in other settings and inform efforts to pinpoint unmet clinical needs.
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